Strain and Counterstrain Flashcards
Direct Treatment
Engaging the restrictive barrier and directions a force in the direction of the barrier
Find limitation and push beyond it (stretching, joint mobilization)
Indirect Treatment
Treatment focused on moving away from the barrier
Find restriction and move away from it (shorten, SCS)
SCS
indirect treatment technique in which dysfunctional tissue is placed in a position of comfort to assist in addressing neuromuscular dysfunction
L. Jones definition of SCS
inappropriate proprioceptor activity
passively putting tissue into its position of comfort (shortened)
Somatic Dysfunction - Acute
Acute traumatic injuries have predictable presentations - inflammation, pain, etc.
Somatic Dysfunction - Insidious issues
Insidious issues develop over time as the body’s tissues adapt to the stresses placed on the,
Somatic Dysfunction
A combination of the two (acute and insidious) results in dysfunction
Muscle spindle
sens to stretch
intrafusal (gamma) and extrafusal (alpha)
Review the rationale for SCS
Injury –> agonist legthens, antagonist shortens
Gamma firing of shortened muscle spindle decreases
Stretch reflex of stretch muscle occurs –> muscle contraction and inhibition of shortened muscle
Gamma efferent of shorteneed is increased as lengthening is attempted due to agonist contraction
This causes the muscle spindle of shortened muscle to rest as it thinks this shortened position is normal
This increase in gamma gain continues until there is intervention
Lengthened muscle still tries to shorten but is inhibited from doing so by the shortened muscles reflex
Results in lengthened muscle becoming weaker –> muscle inbalance
Tender Point
Localized facilitation of a particular point in a muscle
Results in increased muscle tone –> dec
Localized blood supply –> ischemia –> inc sens to pressure
Tender points become more active when
the tissue is stressed
Dynamic Neutral
position in which tissue motion is unrestricted and within the range of normal physiological limits
Ease
Mid-range of motion where the tissue is at its least tense
The position of ease is often the position of strain - clinicall relevant - stuff stuck in drawer
Treatment sequence
Locate muscle/tissue to be treated
Shorten the muscle/tissue
Hold shortened position
Slowly return the muscle passive to neutral
Locate area to be treated
feel tissue for quality
look for points (size, tenderness, depth)
Shorten the muscle/tissue
One hand maintains light observational pressure
One hand moves the body to shorten the tissue
Look for 70% or better resolution of pain
Maintain the shortened position
hold position for 90 seconds to 20 minutes
-allow muscle spindle to rest
Continually monitor the tender point
Return tissue to neutral position
Slowly, passively, return the body/tissue to its neutral position
DO NOT allow the patient to assist
Re-assessment
Re-assess the level of tenderness of tissue treated
Re-assess ROM, strength, etc
Repeat as necessary
Order of treatment
Proximal to distal
Larger joints prior to smaller joints
If multiple pojts, treat most tender first
If points in row; treat center first
General rules
No pain
Not too much pressure over point during rx
Warn patient that there may be post-treatment soreness
Contraindications
Malignancy
Skin conditions
Infectious conditions
Generalized Treatment Order
Address acute issues that prevent use of manual treatment
SCS (indirect)
MET, joint mob (direct tx)
Exercise
